[Cardiopulmonary bypass in cardiac surgery]
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Published on: September 22, 2017
1Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Insights
Cardiopulmonary bypass (CPB) can cause systemic inflammation and organ dysfunction. Minimized systems with biocompatible surfaces help reduce these CPB-related inflammatory responses.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Biomaterials Science
Context:
- Cardiopulmonary bypass (CPB) is essential for cardiac surgery but can lead to systemic inflammation and organ dysfunction.
- The systemic inflammatory response syndrome (SIRS) is triggered by blood contact with artificial surfaces, mechanical stress, and surgical trauma during CPB.
- Despite risks, CPB remains crucial for most cardiothoracic procedures.
Purpose:
- To review the inflammatory and organ-specific complications associated with cardiopulmonary bypass (CPB).
- To discuss technical and surgical advancements aimed at mitigating the inflammatory response to CPB.
- To evaluate the efficacy of minimized CPB systems and biocompatible surfaces in reducing CPB-associated complications.
Summary:
- CPB initiates systemic inflammation (SIRS) due to blood-surface interactions, mechanical stress, and surgical trauma.
- Minimized CPB systems utilizing biocompatible surfaces effectively attenuate the inflammatory response.
- While off-pump surgery offers an alternative, it has limitations and cannot replace conventional CPB.
Impact:
- Highlights the need for strategies to reduce CPB-induced inflammation and organ damage.
- Demonstrates the potential of biocompatible materials and minimized systems in improving patient outcomes during cardiac surgery.
- Informs the development of safer CPB techniques and patient management protocols.
Abstract:
Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.
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